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실데나필

Sildenafil

Sildenafil citrate

혈관 확장제 - 제5형 포스포디에스테라제 (PDE5) 억제제POIV개고양이

다른 이름: Viagra · Revatio · Aphrodil · UK 92480-10 · Sildenafil citrate

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

1.9 mg/kg (range from 0.5-2.7 mg/kg)PO· q8-24h
— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증용량경로빈도기간지역
Pulmonary hypertension1.9 mg/kg (range from 0.5-2.7 mg/kg)POq8-24h—🌎 NA
Pulmonary hypertension documented by Doppler, chronic pulmonary disease, right-sided heart failure (HW disease; congenital)0.5-1 mg/kg (higher dose of 2 -3 mg/kg three times a day may be tolerated and needed)POtwo times daily—🌎 NA
Moderate to severe PH secondary to either left heart disease or primary lung disease1 mg/kgPOq8h—🌎 NA
Pulmonary hypertension1-2 mg/kgPOthree times daily—🌎 NA
Pulmonary arterial hypertension0.5-2.7 mg/kg (suggested median dose from clinical studies is 3 mg/kg/day)POq8-24h—🌍 EU
  • Pulmonary hypertension: Median dose from a retrospective study. Dogs may have been also treated with oxygen, ACE inhibitors, furosemide, amlodipine, diltiazem, theophylline, phenobarbital and/or antibiotics.
  • Pulmonary arterial hypertension: Improves quality of life despite lack of significant echocardiographic reduction in pressures.

고양이

적응증용량경로빈도기간지역
Moderate to severe PH secondary to either left heart disease or primary lung disease1 mg/kgPOq8h—🌎 NA
Pulmonary arterial hypertension1.6 mg/kgPOq12h—🌍 EU
  • Pulmonary arterial hypertension: Reported dose tolerated and clinically efficacious.

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

실데나필은 강력한 ​제5형 포스포디에스테라제(PDE5) 억제제​입니다. 인의에서는 주로 발기부전 치료제로 알려져 있지만, 수의 약리학에서는 ​폐동맥 고혈압(PH)​ 치료의 핵심 약물입니다.

  • ​임상 요점​: 만성 이첨판 질환, 심장사상충증 또는 원발성 폐질환(예: 폐섬유증)으로 인해 폐동맥 고혈압이 발생한 개와 고양이에게 특히 효과적입니다.
  • 폐동맥 혈관상을 선택적으로 확장시킴으로써 우심실 후부하를 크게 감소시키고, 실신, 운동 불내성 및 우측 울혈성 심부전과 같은 임상 증상을 개선합니다.
  • 폐혈관에 대한 특이성이 높아, 다른 혈관 확장제와 병용하지 않는 한 일반적으로 심각한 전신성 저혈압을 유발하지 않습니다.

작용 기전

Sildenafil exerts its effects via the nitric oxide (NO) pathway in smooth muscle cells:

  • Endothelial cells release ​Nitric Oxide (NO)​ → activates the enzyme guanylate cyclase → converts GTP to ​cyclic guanosine monophosphate (cGMP)​.
  • cGMP acts as a secondary messenger causing smooth muscle relaxation and vasodilation.
  • PDE5 is the enzyme responsible for degrading cGMP, and it is found in high concentrations in the pulmonary vasculature and corpus cavernosum.
  • Mechanism: Sildenafil competitively inhibits PDE5 → prevents cGMP breakdown → intracellular cGMP accumulates → resulting in prolonged and enhanced NO-mediated pulmonary vasodilation.

안전성·주의사항

금기사항

  • Concurrent use with organic nitrates
  • Known hypersensitivity to sildenafil
  • Pulmonary veno-occlusive disease (PVOD)
  • Systemic hypotension
  • Significant hepatic impairment
  • Significant renal impairment
  • Bleeding disorders
  • Concurrent use of nitrates

부작용

  • Cutaneous flushing of the inguinal region
  • Gastrointestinal effects (possible)
  • Headache, visual disturbances, dyspepsia, nasal congestion, myalgia, priapism, dizziness, and back pain (reported in humans)
  • Vomiting
  • Dizziness / weakness
  • Raised intraocular pressure
  • Systemic hypotension (especially if combined with other vasodilators)

주의

WARNING: Sildenafil should not be used concurrently with nitrates due to the risk of life-threatening hypotension.

  • Pulmonary vasodilators may significantly worsen the cardiovascular status of patients with pulmonary veno-occlusive disease (PVOD).
  • Use with extreme caution in patients with resting hypotension, fluid depletion, severe left ventricular outflow obstruction, or autonomic dysfunction.

약물 상호작용

Alpha-adrenergic blockers (e.g., phentolamine, phenothiazines, phenoxybenzamine)

May increase hypotensive effects

Amlodipine

Potential to increase hypotensive effects

Antihypertensive, hypotensive drugs

Potentially could increase hypotensive effects

Azole antifungals (ketoconazole, itraconazole)

May reduce sildenafil metabolism and increase AUC

CimetidineModerate

May reduce sildenafil metabolism and increase AUC

Erythromycin, Clarithromycin

May reduce sildenafil metabolism and increase AUC

Heparin

May increase bleeding risks

Nitrates (e.g., NTG, Isosorbide)

Significant potentiation of vasodilatory effects; life-threatening hypotension possible

Nitroprusside sodium

Significant potentiation of vasodilatory effects; life-threatening hypotension possible

PhenobarbitalModerate

May decrease sildenafil concentrations

Rifampin

May decrease sildenafil concentrations

ErythromycinModerate

Increases plasma sildenafil concentration

ItraconazoleModerate

Increases plasma sildenafil concentration

Alpha-adrenergic blockersMajor

Increased risk of systemic hypotension; should not be started at the same time

NitratesMajor

Significantly enhances hypotensive effect; concomitant use must be avoided

모니터링

  • Clinical efficacy (improved syncope, cough, respiratory effort)
  • Pulmonary artery pressure
  • Systemic blood pressure
  • Adverse effects
  • Clinical signs of pulmonary hypertension (exercise tolerance, syncope, respiratory rate/effort)
  • Echocardiography (to monitor right heart function and pulmonary pressures)
  • Intraocular pressure (if pre-existing ocular disease)

약동학

반감기

개approximately 6 hours (significant interpatient variability)

흡수

Oral bioavailability is approximately 50% in dogs (higher than humans).

분포

Volume of distribution is about 5.2 L/kg in dogs (versus 1.2 L/kg in humans).

대사

Hepatic metabolism (implied by interactions with CYP inhibitors/inducers).

배설

Excreted primarily as metabolites.

과다투여

Little information is available in veterinary species. In humans, massive overdose (2000 mg) resulted in tachycardia, nonspecific ST-T changes on ECG, headache, dizziness, and flushing.

It is expected that overdoses in animals would mirror the drug's adverse effect profile (e.g., profound hypotension, tachycardia, cutaneous flushing). ​Treat supportively.​

제품

제형

  • Oral tablets
  • Injection solution
  • 20 mg tablet
  • 50 mg tablet
  • 6.25 mg tablet (special reformulation)
  • 10 mg tablet (special reformulation)
  • 12.5 mg tablet (special reformulation)
  • 10 mg/ml oral suspension
  • 0.08 mg/ml injectable (IV)

동물용의약품

  • Special reformulations available: 6.25 mg, 10 mg and 12.5 mg tablets

인용의약품

  • Sildenafil Citrate Oral Tablets: 20 mg Revatio® (Pfizer); 25 mg, 50 mg & 100 mg Viagra® (Pfizer)
  • Sildenafil Injection Solution: 10 mg/12.5 mL (dextrose 50.5 mg/mL) in 12.5 mL single-use vials; Revatio® (Pfizer)
  • Revatio (20 mg tablets, 10 mg/ml oral suspension, 0.08 mg/ml IV)
  • Viagra (25 mg, 50 mg tablets)

규제 현황

European Union✓ 승인됨처방전의약품EMA

POM (Prescription Only Medicine). Used off-label under the cascade.

United Kingdom✓ 승인됨처방전의약품VMD

POM-V / POM. Used off-label under the prescribing cascade.

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Sildenafil tablets should be stored at room temperature (25°C; 77°F); excursions permitted to 15-30°C (59-86°F).

보호자 정보

​중요​: 실데나필은 수의학에서 폐의 고혈압(폐동맥 고혈압)을 치료하기 위해 '허가 외 사용(off-label)'으로 자주 처방됩니다.

  • ​기대 효과​: 반려동물의 활력이 증가하고, 기침이 줄어들며, 기절(실신)하는 횟수가 감소하는 것을 볼 수 있습니다.
  • ​비용​: 이 약은 인의용 의약품(주로 Viagra® 또는 Revatio®로 알려짐)이므로 비용이 비쌀 수 있습니다. 비용이 부담된다면 수의사와 제네릭 약품이나 조제약에 대해 상의하세요.
  • ​안전 경고​: 실데나필을 복용하는 동안에는 ​절대​ 다른 심장약, 특히 ​질산염 제제​(예: 니트로글리세린)를 주지 마세요. 치명적인 혈압 저하를 유발할 수 있습니다.
  • ​부작용​: 배(서혜부) 부위가 붉어지거나 위장 장애가 있는지 관찰하세요. 반려동물이 어지러워하거나 무기력해 보이거나 쓰러지면 즉시 수의사에게 연락하세요.

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